January 30, 2015
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Intracytoplasmic sperm injection use surges amongst fertile men

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The use of intracytoplasmic sperm injection doubled over a 16-year period, but was not associated with improved postfertilization reproductive outcomes, compared to conventional in vitro fertilization, regardless of male factor infertility, according to a recently published study.

“[Intracytoplasmic sperm injection] increases the likelihood of fertilization in the context of male factor infertility,” Sheree L. Boulet, DrPH, MPH, of the Division of Reproductive Health at the CDC, and colleagues wrote. “In contrast, implantation rates were also lower when [intracytoplasmic sperm injection] was used and likely contributed to the significantly lower rates of multiple live births.”

Sheree L. Boulet

Boulet and colleagues studied data on 1,395,634 fresh in vitro fertilization (IVF) cycles from the US National Assisted Reproductive Technology Surveillance System, gathered from 1996 to 2012. Intracytoplasmic sperm injection was used in 65.1% of patients, with 35.8% reporting male factor infertility. When infertility was reported, intracytoplasmic sperm injection (ICSI) use increased from 76.3% to 93.3% (P<.001). In fertile men, the use of ICSI increased from 15.4% to 66.9% (P<.001).

Infertility was reported in 35.7% of patients of fresh cycles from 2008 to 2012, with intracytoplasmic sperm injection use being associated with a lower multiple birth rate, compared to conventional IVF (30.9% vs. 34.2%; adjusted RR=0.87; 95% CI, 0.83-0.91). In cycles without male factor infertility (n=317,996), ICSI was linked to lower rates of implantation (23% vs. 25.2%; adjusted RR=0.93; 95% CI, 0.91-0.95), live birth (36.5% vs. 39.2%; adjusted RR=0.95; 95% CI, 0.93-0.97) and multiple birth (30.1% vs. 31%; adjusted RR=0.93; 95% CI, 0.91-0.95), compared to conventional IVF.

“The use of ICSI is increasing for all types of IVF cycles, and especially for cycles without a diagnosis of male factor infertility. Our findings suggest that ICSI did not result in improved reproductive outcomes. Therefore, the risks and benefits of using ICSI should be carefully considered,” Boulet told Healio Family and Internal Medicine.

Disclosure: The researchers report the study was supported by the National Center for Advancing Transitional Sciences. See the study for a full list of the researchers’ relevant financial disclosures.